Name
*
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
What county do you live in?
*
Bedfordshire
Berkshire
Bristol
Buckinghamshire
Cambridgeshire
Cheshire
City of London
Cornwall
Cumbria
Derbyshire
Devon
Dorset
Durham
East Riding of Yorkshire
East Sussex
Essex
Gloucestershire
Greater London
Greater Manchester
Hampshire
Herefordshire
Hertfordshire
Isle of Wight
Kent
Lancashire
Leicestershire
Lincolnshire
Merseyside
Norfolk
North Yorkshire
Northamptonshire
Northumberland
Nottinghamshire
Oxfordshire
Rutland
Shropshire
Somerset
South Yorkshire
Staffordshire
Suffolk
Surrey
Tyne and Wear
Warwickshire
West Midlands
West Sussex
West Yorkshire
Wiltshire
Worcestershire
Phone
(###)
###
####
Email
*
Are you currently in Education?
*
Yes, full-time
Yes, part-time
No
Do you currently have any support from a social worker, personal advisor or local authority team? If so, please can you provide a contact name and email/number.
*
If you do not have a social worker or personal advisor, do you have someone we can contact as a reference to confirm your situation? (Doctor, teacher, lecturer, employer, etc).
*
What type of accommodation do you have? (supported accommodation, semi supported, rented house, home owner, shared accommodation, living with partner, living with family/foster family, youth hostel, B&B, etc).
*
Are you in receipt of any benefits? If so, how much and when do you get paid.
*
Are you employed?
*
Yes, full-time
Yes, part-time
Yes, casual working
No
If employed, how much do you get paid and how often?
Please tell us about your time in care and what support you had/currently have since leaving care.
*
What are you applying for and why? (Food vouchers, equipment support, transport support, costs of living and bills, etc).
*
Do you know how much you need?
*
What support have you previously applied for from other organisations or what support have you already accessed?
*
What might help change your circumstances for the longer term? (accessing your rights and entitlements, changes in benefits, changes in job circumstances, access to student finance, etc).
*
I consent to Avocados contacting my professional contact, social worker, PA or equivalent to confirm my care experience with regards to processing this application for crisis support.
*
Yes
No